Telemedicine 101: What You Need to Know
By Lydia Noyes
Photo by Getty Image/Halfpoint
Does skyping your doctor for your next appointment sound like a stretch? It might not be for long. Telemedicine is taking off, and its growing popularity has the potential to guide the future of healthcare in a completely new direction. Many people are wondering whether telemedicine is a solution for their needs, especially with its promise of faster and cheaper healthcare. Let’s look at what virtual health technology can provide, and evaluate the benefits and concerns of this expanding industry.
What is Telemedicine?
Telemedicine is broadly defined as any professional communication between a doctor and their patient when they aren’t in the same physical location. Through technology, such as cell phones and the internet, healthcare professionals can virtually evaluate, diagnose, and prescribe treatments to their patients. Many companies offer 24/7 access to doctors for professional medical advice, and some maintain contracts with specialists from around the world. Rural medical practices in particular can use telemedicine to receive outside counsel during emergencies, or reach more people in isolated areas.Thanks to smartphones, the barriers for using telemedicine are disappearing. This makes virtual healthcare a more feasible option in patients’ homes, assisted living facilities, and other locations where traditional medical care may be inconvenient. Today, the technology is used to diagnose ailments such as colds, skin rashes, allergies, asthma, mental illness, lower back pain, urinary tract infections, diabetes, and hypertension.
Photo by Getty Images/artisteer
Virtual Medicine’s History and Growth
References to telemedicine in the medical world first began in the 1950s, when Pennsylvania medical staff transmitted radiologic images through telephones. But experiments within the space program are responsible for catapulting virtual medicine forward. NASA used telemedicine throughout the 1960s to monitor astronauts’ health while they were in space, including during the first moon landing in 1969. Even so, virtual medicine equipment was still too complex to be practical for home visits, at least until common use of the internet.
In recent years, remote medical service has increasingly become part of the mainstream healthcare system. A 2017 survey reports that about 75 percent of the medical providers who responded now offer, or plan to offer, some form of telemedicine. In 2012, the American Telemedicine Association estimated that there were approximately 200 telemedicine networks and 3,500 service sites across the country.
That’s not to say the practice is ubiquitous. One survey shows that close to 40 percent of Americans haven’t heard of telemedicine, and another states that only 15 percent of surveyed physicians regularly used telehealth services within a 12-month window. However, a third poll shows that almost 90 percent of Americans age 40 and older have reported they would be willing to use it.
But telemedicine’s influence isn’t just within the United States. The global telemedicine industry is expected to be valued at almost $80 billion by 2020.
Advantages of Telemedicine
Is an internet-based doctor’s appointment more appealing than a traditional one? For many, the answer is yes. One report shows that most respondents express satisfaction after using telemedicine for their medical care. Another study reported that participants ranked telemedicine as non-inferior to in-person services; were more satisfied by the convenience of telemedicine; and were satisfied with the quality of communication and competence of the physician.
Other factors may also contribute to telemedicine’s attractiveness for patients. Long wait times and rushed appointments at a doctor’s office may make some patients willing to try telemedicine, especially for minor, recurring ailments. Many telemedicine platforms also offer options for 24/7 nonemergency medical consultations that make it easy to receive an expert opinion while avoiding the high fees related to on-site, urgent care treatment. For instance, each virtual visit typically costs less than $50, as opposed to $100 to $150 for in-person or urgent care visits. Likewise, when travel time isn’t an issue, patients can more easily fit doctors’ appointments into their busy schedules, leading to less missed work time. Staying away from hospitals also reduces patients’ exposure to other illnesses during a visit.
Patients aren’t the only ones who benefit from telemedicine; the practice seems to make sense for doctors, too. Health practitioners may be able to lower their costs with remote diagnosis. Video appointments typically shorten the time of each visit, allowing doctors to see more patients per day.
Telemedicine may also reduce the instances of no-shows and cancellations, because the appointments are more convenient for patients to keep.
Photo by Getty Images/Nastasic
Specialty Care and Virtual Medicine
Telemedicine also transforms traditional medical services by improving patient access to specialty care. The technology is ideal for psychiatry, because it allows specialists to work virtually with patients far beyond their geographic range. Areas with a health professional shortage have just one provider for every 30,000 (or more) U.S. citizens. However, video visits can increase opportunities for people, especially in these high-need areas, to receive treatment.
Additionally, telemedicine is improving access to specialty care for inmates. Most prisons are located in rural areas, far from cancer and heart treatment centers, and securely transporting inmates to a physical office is expensive. According to a 2011 survey from the Centers for Disease Control and Prevention, 30 of the 45 states polled reported that they use telemedicine for part of their prison healthcare process, primarily for psychiatry and cardiology treatment.
Despite telemedicine’s rapid expansion, critics are questioning whether the practice makes sense in the long run. Some primary care providers fear that offering video visit services implies that their in-office care is lower quality than that of their physical office competition, potentially giving those competitors an edge. Access to technology can also be a hurdle. In most cases, setting up and using telemedicine platforms requires expensive training and equipment purchases (though some secure video chat services work with a regular webcam). Standard video apps, such as FaceTime and Skype, aren’t secure enough for medical visits, and regulatory issues may affect the effectiveness of available technology.
Critics of telemedicine also worry that receiving advice from a doctor whom you’ve never met in person will prevent you from receiving personalized, quality care. Some research backs up these concerns. A published study found that in 62 telemedicine encounters, one-third or less of them offered patients a choice between doctors, disclosed the clinician’s credentials, or discussed common side effects of prescribed medication. Some also misdiagnosed conditions because they failed to ask the right follow-up questions.
Photo by Getty Images/Geber86
Setting Telemedicine Standards
To combat these concerns, the American Telemedicine Association and other organizations have started accreditation programs that help patients identify the best telemedicine providers. Likewise, the American Medical Association provides ethical guidelines for telemedicine care that call for doctors to recognize their limits and to ensure that they have as much information about every patient as possible before making recommendations.
Creating this connection between physician and patient may include a face-to-face examination (either in-person or through real-time video calls), a consultation with a physician who has established an ongoing relationship with the patient, or a commitment to meet established telemedicine guidelines for patient-physician relationships. Even so, there’s little overall agreement about what the limits of virtual medicine are, leaving some diagnoses up to the discretions of different medical companies.
The telemedicine industry also needs to establish standards for who will pay for these services. Insurance coverage and reimbursement rates for telemedicine vary on a state and supplier level, and existing federal plans only cover a small number of services. At present, 32 states have parity laws that require private insurers to reimburse doctors for remote treatment if the same service would otherwise be covered for an in-person visit. Several states have also joined a compact that allows doctors licensed in one state to obtain a license in another, making it easier for specialists to treat patients in participating states. The level of reimbursement can vary across states, though most come close to the reimbursement rates for in-person visits.
National programs are also slow to adapt. Medicare will cover only a few telemedicine services, and the regulations for Medicaid vary considerably by state. Most cover telemedicine in some capacity, but the rules and requirements vary considerably.
Telemedicine has a bright future, but whether it becomes better accepted depends on how regulators, providers, and physicians address some of the challenges it currently faces. If you’re willing to experiment with virtual medicine, you might be amazed by how it improves your healthcare quality, costs, and efficiency this year.
How Telemedicine Works
Telemedicine today uses technology to simplify healthcare for both patients and providers. Most “visits” rely on the internet to transmit voice, images, and/or video from the patient to the doctor. There are three main ways that telemedicine is used:
- Store-and-forward: This method works as a secure email system to share private patient data online without compromising it. Store-and-forward works best in situations that don’t call for a real-time conversation, such as a clinic sharing X-rays with a remote specialist for diagnosis.
- Remote monitoring: This technique allows physicians to monitor a patient’s vital signs off-site through specialty tracking tools, such as phone apps, mobile medical devices, and wearables. Remote monitoring is typically used to manage chronic conditions, including diabetes.
- Interactive services: These services provide face-to-face interactions in real time between the doctor and patient, often to diagnose and prescribe treatment within a virtual visit. Secure video calls are a classic example of interactive telemedicine.
Telemedicine VS. Telehealth
While the terms “telemedicine” and “telehealth” are often used interchangeably, they don’t mean the same thing, and it’s helpful to know the difference.
- Telehealth is a broad categorization for all technology used within the healthcare industry, including staff training opportunities, administrative meetings, and public awareness campaigns.
- Telemedicine, in contrast, refers only to the use of electronic communication for providing clinical services to patients without an in-person appointment.
Lydia Noyes is a freelance writer and hobby farmer on a 33-acre property in western Michigan. You can find her online at First Roots Farm.
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